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Sepsis, Emergency Medicine

Reviewed 06/2017
 


Basics

Description

  • Presence of an infection with an associated systemic inflammatory response

  • The systemic inflammatory response syndrome (SIRS) is composed of 4 criteria:

    • Temperature >38°C or <36...

Diagnosis

Signs and Symptoms

History

  • Question for signs of infection and a systemic inflammatory response:

    • Fever

    • Dyspnea

    • Altered mental status:

      • Change in mental status

      • Confusion

      • Delirium

    • Nausea and vomiting

  • Loo...

Treatment

Pre-Hospital

Aggressive fluid resuscitation for hypotension 

Initial Stabilization/Therapy

  • ABCs

  • Supplemental oxygen to maintain PaO2 >60 mm Hg

  • Intubation and mechanical ventilation if shock or...

Follow-Up

Disposition

Admission Criteria

Sepsis almost always requires inpatient care. 

Discharge Criteria

Patients with less severe infections (e.g., streptococcal pharyngitis) meeting the criteria for s...

Pearls and Pitfalls

  • Start antibiotics as soon as sepsis is suspected.

  • Failure to recognize multiorgan failure and initiate aggressive fluid resuscitation in the initial presentation of sepsis is a pitf...

Additional Reading

  • Barochia  AV, Cui  X, Vitberg  D, et al. Bundled care for septic shock: An analysis of clinical trials. Crit Care Med.  2010;38:668–678.

  • Martin  JB, Wheeler  AP. Approach to the...

Codes

ICD9

  • 038.42 Septicemia due to escherichia coli [E. coli]

  • 038.43 Septicemia due to pseudomonas

  • 995.91 Sepsis

  • 079.99 Unspecified viral infection

  • 038.10 Staphylococcal septicemia, unspecified

  • 038.40 Sept...

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